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This is the complete lecture note for SUG601 Plastic Surgery and Burns. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: SUG 601 Course title: Plastic Surgery and Burns Course credit load: 2 Units Series 1: Symptoms and Signs of Common Lesions in Plastic and Reconstructive Surgery • Part 1.1: Approach to Common Skin and Soft Tissue Lesions o Sub Part 1.1.1: Principles of lesion assessment: history and examination o Sub Part 1.1.2: Interpreting key symptoms in cutaneous lesions o Sub Part 1.1.3: Interpreting key signs in cutaneous lesions • Part 1.2: Benign Cutaneous and Subcutaneous Lesions o Sub Part 1.2.1: Naevi and pigmented lesions o Sub Part 1.2.2: Cysts and lipomas o Sub Part 1.2.3: Keloids and hypertrophic scars • Part 1.3: Malignant and Premalignant Skin Lesions o Sub Part 1.3.1: Basal cell carcinoma o Sub Part 1.3.2: Squamous cell carcinoma o Sub Part 1.3.3: Malignant melanoma • Part 1.4: Ulcers and Sinuses: Symptoms and Signs o Sub Part 1.4.1: Chronic wounds and ulcers: clinical features o Sub Part 1.4.2: Sinuses and fistulae: clinical features o Sub Part 1.4.3: Interpreting lesion signs to guide differential diagnosis Introduction A small lump noticed in the shower, a mole that has started to change, a wound that simply will not heal, these are the everyday complaints that bring patients to a plastic and reconstructive surgery clinic, and behind each one lies a specific set of symptoms and signs waiting to be correctly read. This opening Series of Plastic Surgery and Burns builds the foundation for
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS everything that follows in the course, teaching you to recognise, describe, and interpret the symptoms and signs of the lesions most commonly encountered in this specialty. Getting this foundation right matters enormously, since the whole discipline of plastic and reconstructive surgery rests on accurate lesion recognition before any decision about investigation or treatment can be made. The aim of this Series is to equip you with the ability to list the symptoms and signs of common lesions in plastic and reconstructive surgery and to interpret them accurately, covering the general approach to lesion assessment, benign cutaneous and subcutaneous lesions, malignant and premalignant skin lesions, and chronic wounds, ulcers, and sinuses. Each of these categories presents with a recognisable, learnable pattern of symptoms and signs, and by the end of this Series you should be able to approach an unfamiliar lesion systematically rather than relying on memorised diagnoses alone. This Series opens with the general approach to common skin and soft tissue lesions, moves through benign cutaneous and subcutaneous lesions and malignant and premalignant skin lesions, and closes with ulcers and sinuses, building a comprehensive picture of lesion recognition across the specialty. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: list the symptoms of common lesions encountered in plastic and reconstructive surgery • SLO 1.2: list the signs of common lesions encountered in plastic and reconstructive surgery • SLO 1.3: describe the clinical features that distinguish common benign cutaneous and subcutaneous lesions • SLO 1.4: interpret symptoms and signs to differentiate between benign lesion types • SLO 1.5: describe the clinical features of malignant and premalignant skin lesions • SLO 1.6: interpret signs that raise suspicion of malignancy in a skin lesion • SLO 1.7: describe the clinical features of chronic ulcers, sinuses, and fistulae • SLO 1.8: interpret symptoms and signs to guide the differential diagnosis of common lesions
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Approach to Common Skin and Soft Tissue Lesions 1.1.1 principles of lesion assessment: history and examination Building a systematic foundation for every lesion A sound lesion assessment begins with a focused history covering the duration of the lesion, its rate of growth, any associated pain, itching, bleeding, or discharge, and relevant risk factors such as sun exposure, occupational exposure, smoking, or a family history of skin cancer. The history alone often narrows the differential diagnosis considerably before the lesion is even examined, since a rapidly growing, painless lump raises different concerns from a slow-growing lesion present unchanged for many years. Asking about previous similar lesions and any prior treatment received also helps place the current presentation in proper clinical context. Examination follows a structured sequence: inspection of site, size, shape, colour, and surface characteristics, followed by palpation to assess consistency, mobility, tenderness, and temperature, and, where relevant, assessment of the regional lymph nodes and surrounding tissue. Systematic examination in this order avoids missing important findings and allows the same lesion to be reliably re-examined and compared at a later visit, which is particularly important for lesions being monitored over time rather than treated immediately. Photographic documentation at each visit is increasingly used to support this comparison and should be considered standard practice wherever available. Fill in the blank: A rapidly growing, painless lump raises different concerns from a lesion present unchanged for many ________. 1.1.2 interpreting key symptoms in cutaneous lesions What the patient reports and why it matters Symptoms reported by the patient, such as pain, itching, bleeding, discharge, or a change in size or colour, each carry distinct diagnostic weight and should never be dismissed as incidental. Pain in an otherwise unremarkable lesion can indicate inflammation, infection, or nerve involvement, while itching is more commonly associated with benign inflammatory or allergic processes, though persistent itching in a pigmented lesion can also be an early warning sign of malignant change that deserves careful attention. Bleeding from a lesion, particularly spontaneous bleeding without trauma, is a symptom that should always prompt closer evaluation given its association with both benign vascular lesions and malignant change. A reported change in size, shape, or colour over time is one of the most clinically significant symptoms a patient can offer, since stability over years favours a benign process while recent, progressive change favours a process requiring urgent further evaluation. Eliciting this history
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS accurately requires specific, direct questioning, since patients do not always volunteer subtle changes unprompted, and a general question such as asking whether anything has changed about the lesion recently should be a routine part of every consultation regardless of how obviously benign the lesion first appears. Fill in the blank: Persistent itching in a pigmented lesion can be an early warning sign of malignant ________. 1.1.3 interpreting key signs in cutaneous lesions What examination reveals and how to read it Signs identified on examination, including irregular borders, colour variation, ulceration, surface texture, and fixation to underlying structures, provide objective evidence that complements the patient's reported symptoms. An irregular, poorly defined border and marked colour variation within a single lesion are both classic warning signs associated with malignant melanoma, while a smooth, well-defined border and uniform colour are more reassuring features typical of benign pigmented lesions, though neither feature alone is ever fully diagnostic in isolation. Fixation of a lesion to deeper structures, meaning it cannot be moved independently of the tissue beneath it, is a particularly important sign suggesting local invasion and warrants prompt further investigation rather than reassurance. Ulceration of a previously intact lesion, especially in the absence of trauma, similarly raises concern and should be interpreted alongside the full clinical picture rather than in isolation, since the significance of any single sign depends heavily on the context of the lesion as a whole. Fill in the blank: Fixation of a lesion to deeper structures suggests local ________ and warrants further investigation.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Figure 1.1: A surgeon examining a skin lesion, assessing its borders and mobility. Pilot questions 1.1 1. List the key elements of a focused lesion history. (Linked to SLO 1.1) 2. Explain why rate of growth is an important historical feature. (Linked to SLO 1.1) 3. Describe the structured sequence followed during lesion examination. (Linked to SLO 1.2) 4. Explain the diagnostic significance of spontaneous bleeding from a lesion. (Linked to SLO 1.1) 5. Explain why fixation to underlying structures is a concerning sign. (Linked to SLO 1.2) 1.2 Benign Cutaneous and Subcutaneous Lesions 1.2.1 naevi and pigmented lesions Common pigmented lesions and their typical features Naevi, commonly known as moles, are among the most frequently encountered pigmented lesions, typically presenting as well-defined, symmetrical, uniformly coloured lesions that remain stable in appearance over long periods of time. Congenital naevi are present from birth and can vary considerably in size, while acquired naevi typically appear during childhood and
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS adolescence and gradually stabilise in adulthood, a pattern of evolution that is itself reassuring when it follows the expected course. Other pigmented lesions encountered in practice include seborrhoeic keratoses, which present as well-demarcated, waxy or warty lesions with a stuck-on appearance, and solar lentigines, flat pigmented patches associated with cumulative sun exposure. Distinguishing these benign
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